Cold lesions on bone scan in pediatric neoplasms

A retrospective examination of the bone scans of 425 pediatric oncology patients was undertaken to determine the incidence of photon-deficient (cold) lesions in this population. Eight patients (1.8%) had cold lesions due to a wide variety of tumors. Of the tumor types, six had not been previously reported to give cold lesions on bone scan. The appearance of the radiograph at the site of the cold lesion was normal in five of the eight patients. All but one of the patients had "hot spots" as well as a cold lesion. Follow-up scans showed resolution of the cold lesions in two cases and a change from cold to hot in one case. A review of the literature revealed eight cases of cold lesions on bone scan due to tumor in pediatric patients. The previous reports included five patients with neuroblastoma and three with osteosarcoma.